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2019 Select by Medica Official Documents

To see your summary of benefits and coverage (SBC) and policy of coverage documents, select your state and plan below.

Looking for the 2018 official documents?

Kansas Plans

Document Care Type    
Summary of Benefits and Coverage (SBC) Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Policy of Coverage
Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Document Care Type  
Summary of Benefits and Coverage (SBC)
Bronze HSA Plus (PDF)
Bronze HSA (PDF)
Policy of Coverage
Bronze HSA Plus (PDF)
Bronze HSA (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Gold Share (PDF)
Policy of Coverage
Gold Share (PDF)

Missouri Plans

Document  Care Type    
Summary of Benefits and Coverage (SBC) Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Policy of Coverage
Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Gold Share (PDF)
Policy of Coverage
Gold Share (PDF)
Date: 9/16/2019 7:45:08 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB02